Brown Syndrome is a rare eye disorder characterized by defects in eye movements. This disorder may be present at birth (congenital) or may occur as the result of another underlying disorder (acquired). Muscles control the movements of the eyes. Some of these muscles turn the eyeball up and down, move the eyeball from side to side, or enable the eyeball to rotate slightly in its socket. The superior oblique tendon sheath of the superior oblique muscle surrounds the eyeball. The symptoms of Brown Syndrome are caused by abnormalities of this tendon sheath including shortening, thickening, or inflammation. This results in the inability to move the affected eye upward.

Symptoms of Brown Syndrome

In most cases, only one eye is affected. This is most often the right eye. But both eyes can be affected. The symptoms can vary in severity.

Brown syndrome limits the normal movements of the eye. For example,

• If Brown syndrome affects the right eye. Your child may not be able to look up with the right eye when their eyes are looking to the left. It may cause mild pain when he or she tries to make this eye movement.
• If Brown syndrome affects the left eye. Your child may not be able to look up with the left eye when their eyes are looking to the right. The eyes might look normal when looking toward the midline or straight ahead. The affected eye might be a bit lower than the other eye.

Causes of Brown Syndrome

Brown's syndrome can be divided in two categorizes based on the restriction of movement on the eye itself and how it affects the eye excluding the movement:

• Congenital (present at birth) Brown's syndrome results from structural anomalies other than a short tendon sheath but other fibrous adhesions may be present around the trochlear area.
• Acquired cases arise from trauma, surgery, sinusitis and inflammation of the superior oblique tendon sheath in rheumatoid arthritis. Orbital floor fractures may trap the orbital tissue in such a way as to simulate Brown's syndrome. Intermittent forms of vertical retraction syndrome have been associated with click, which occurs as the restriction is released (superior oblique click syndrome).

Treatment for Brown Syndrome

Treatment recommendations vary depending on the cause and severity of the condition. In mild cases, a watch and wait approach may be sufficient. Visual acuity should be monitored. First line therapy usually involves less invasive options such as nonsteroidal anti-inflammatory medications like Ibuprofen.  Acquired cases of inflammatory Brown syndrome may be successfully treated with corticosteroids. Surgery is considered in cases which present with double vision, compromised binocular vision, significant abnormalities in head position or obvious eye misalignment when looking straight ahead.

Treatment will depend on your child's symptoms, age, and general health. It will also depend on how severe the condition is. And on what is causing it.

Close watching often works in mild cases.

More severe cases of Brown syndrome may need surgery. Your child may be more likely to need surgery if:

• The eyes are out of alignment when looking straight ahead
• He or she has double vision
• The head position is very abnormal

During this surgery, the eye surgeon may cut the superior oblique muscle tendon and use a device to lengthen it. This may allow the muscle tendon to move normally. The surgery is often successful. But some children need repeat surgery.

Brown syndrome due to other conditions is more likely to go away without surgery. Treating the underlying health condition may help reduce symptoms. For example, someone with Brown syndrome due to lupus might find it helpful to be treated with corticosteroids.

Media Contact:

Sarah Rose

Journal Manager Journal of Eye Diseases and Disorderss

Email: eyedisorders@emedsci.com

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